Deadly new MERS virus spreads to Italy and kills three more in Saudi Arabia

MERS-CoV / virus spreads to Italy, kills three more in Saudi Arabia

Italy reported its first cases of the deadly MERS coronavirus on as three more people die in Saudi Arabia Sunday, bringing the kingdom’s death toll to 24.

A 45-year-old man who had recently returned from a 40-day visit to Jordan was hospitalized in Tuscany, Italy with a high fever, cough and respiratory problems, the country’s health ministry said. Tuscan regional officials say that a young child who is related to the man and a work colleague also have the virus.

All three patients were reported to be in good condition and were being treated in isolation.

The Saudi Arabian Ministry of Health said Sunday the three deceased were among 38 infected in the kingdom with the respiratory virus called MERS.

It says two of the three whose deaths were reported Sunday were suffering from chronic diseases.

The World Health Organization said Saturday prior to the latest Saudi announcement that it was informed of 51 confirmed cases of the new virus since September and 30 cases were fatal.

The new virus is related to SARS, which killed some 800 people in a global epidemic in 2003, and belongs to a family of viruses that most often causes the common cold.

In the world’s eyes, Saudi Arabia appears to be ground zero for the new MERS coronavirus, with the country accounting for nearly 80% of known cases. But the kingdom’s deputy minister of health believes this virus is infecting people around the world, and other countries aren’t catching cases because they aren’t looking.

In a wide-ranging interview, Dr. Ziad Memish also said that while he takes the new virus seriously, he doesn’t believe the outbreak deserves the type of attention it is receiving. The director general of the World Health Organization, Dr. Margaret Chan, called the new coronavirus “a threat to the entire world.”

“We’re spending a lot of money, we’re making a lot of investments trying to see what this disease is about and where it’s coming from and how we can manage it,” said Memish, who received his medical training in Canada.

“But … you know, the H7N9 killed 35 people and there were 134 odd cases in a few weeks. So I think, yes, it’s a concern, but not as big a concern as is being portrayed in the media.” (The latest WHO figures for H7N9 are 132 cases and 37 deaths.)

Memish noted that four million Muslims from around the world have travelled to Saudi Arabia already this year to perform a pilgrimage known as Umrah. “We have not seen anything disastrous to date and, knock on wood, I hope nothing will happen.”

Umrah is secondary to the better known annual Hajj. It can be performed at any time of the year, according to the Saudi Ministry of Hajj, though when Muslims make this pilgrimage during Ramadan, the month of fasting, it is considered equal to doing the Hajj.

This year Ramadan begins July 9 and public health experts are already worrying about whether the influx of pilgrims will lead to spreading MERS around the globe.

Prior to early May, there had only been 17 confirmed cases from five countries: Jordan, Saudi Arabia, Qatar, United Arab Emirates and Britain. (A cluster of three cases in Britain was triggered by the man who became infected while travelling in Saudi Arabia).

Despite the complaints about the kingdom’s lack of transparency, Memish insisted he has been forthcoming.

“People say we’re not transparent. People say we’re not giving information. But as we spoke to the DG” — the director general — “and WHO we said everything that we are learning,” Memish said.

He clearly chafes at the suggestion that the virus is coming from his country, or region.

In fact, in an article Memish published this week in the New England Journal of Medicine, he said an earlier iteration of the WHO’s advice for how to find cases probably led to an underestimation of the scope of the problem, because it linked infections only to countries on and around the Arabian Peninsula. The most recent version of the guidance talks about the Middle East.

“If you ask why we’re picking up more cases in Saudi recently, it’s because we’re just looking harder and harder. We’re processing hundreds of samples a day from different parts of the country. So far we sampled 1,500 or 1,700 samples in the whole of Saudi,” he said.

“I don’t think any country in this world is doing that much testing. And I guess the more you look the more you’ll find.”

If other countries — even countries outside the Middle East — conducted similar testing, they too would find MERS cases, he said. “I would not be surprised if it’s in every other country in the globe.”

He supported that argument with the fact that in many cases of pneumonia, the bacterial or viral cause is never found. Still, Memish’s suggestion that those could be undetected MERS cases met with skepticism from infectious diseases experts.

“To suggest that cases of MERS-CoV” — CoV stands for coronavirus — “infections are being missed all over the world carries no epidemiologic or virologic credibility among those of us who have spent our careers tracking down global emerging infections,” said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

The outbreaks that we’re seeing now would not likely be overlooked even if a country weren’t looking very hard

“Such a statement merely blames the rest of the world for the continued problems with transparency by the Kingdom of Saudi Arabia in responding to this public health crisis.”

Osterholm said if undiagnosed MERS cases were in hospitals in other parts of the world, health-care workers would be contracting the disease as they did SARS in 2003. “They would become the sentinel canaries. We’re not seeing those.”

Gregory Hartl, a spokesperson for the WHO, said if there were clusters of MERS cases elsewhere, they would be garnering attention, testing or no testing. “The outbreaks that we’re seeing now would not likely be overlooked even if a country weren’t looking very hard.”

As well, he noted that some countries have been testing stored blood samples looking for evidence of antibodies to the virus, a finding that would suggest people in those countries had been exposed to MERS in the past. So far there have been no positive findings, he said.

One of the issues that has plagued efforts to find cases, particularly previous cases that were undiagnosed at the time of the infection, is the lack of validated MERS blood tests.

Several laboratories in Europe have developed tests. But in order to be certain that a test is working — that it is picking up true positive cases and is not generating false positives — developers need to test it on blood from people who have survived the infection. The only country with significant numbers of MERS survivors at this point is Saudi Arabia, which has reportedly not responded to requests from some European academic labs that have developed MERS blood tests.

Asked about that, Memish said Saudi Arabia is collaborating on the development of MERS blood tests. He said the country is working with scientists at Columbia University in New York, and with the U.S. Centers for Disease Control.

“We’re working with CDC. We’re just trying to finalize the agreement,” he said.